Provider Demographics
NPI:1538692900
Name:EVANS, EMILY BETH (LPCMH)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:BETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W PARK PL
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1324
Mailing Address - Country:US
Mailing Address - Phone:302-437-5518
Mailing Address - Fax:302-376-6145
Practice Address - Street 1:101 W PARK PL
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1324
Practice Address - Country:US
Practice Address - Phone:302-559-4421
Practice Address - Fax:302-376-6145
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEAC-0000112101YM0800X
DEPC-0000844101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health